Five
More Facts about ICD-10
Last week, the lefts
for Medicare & Medicaid Services
(CMS) shared five facts dispelling
misperceptions about the transition
to ICD-10. Here are five more facts
addressing common questions and concerns
CMS has heard about ICD-10:
1.
If you cannot submit ICD-10 claims
electronically, Medicare offers several
options.
CMS
encourages you to prepare for the
transition and be ready to submit
ICD-10 claims electronically for all
services provided on or after October
1, 2015. But if you are not ready,
Medicare has several options for providers
who are unable to submit claims with
ICD-10 diagnosis codes due to problems
with the provider’s system. Each of
these requires that the provider be
able to code in ICD-10:
o
Free billing software that can
be downloaded at any time from every
Medicare Administrative Contractor
(MAC)
o
In about ½ of the MAC jurisdictions,
Part B claims submission functionality
on the MAC’s provider internet portal
o
Submitting paper claims, if
the Administrative Simplification
Compliance Act waiver provisions are
met
If you take this route,
be sure to allot time for you or your
staff to prepare and complete training
on free billing software or portals
before the compliance date.
2. Practices
that do not prepare for ICD-10 will
not be able to submit claims for services
performed on or after October 1, 2015.
Unless your practice
is able to submit ICD-10 claims, whether
using the alternate methods described
above or electronically, your claims
will not be accepted. Only claims
coded with ICD-10 can be accepted
for services provided on or after
October 1, 2015.
3.
Reimbursement for outpatient and physician
office procedures will not be determined
by ICD-10 codes.
Outpatient and physician
office claims are not paid based on
ICD-10 diagnosis codes but on CPT
and HCPCS procedure codes, which are
not changing. However, ICD-10-PCS
codes will be used for hospital inpatient
procedures, just as ICD-9 codes are
used for such procedures today. Also,
ICD diagnosis codes are sometimes
used to determine medical necessity,
regardless of care setting.
4.
Costs could be substantially lower
than projected earlier.
Recent
studies by 3M
and the Professional
Association of Health Care Office
Management
have found many EHR vendors are including
ICD-10 in their systems or upgrades
—at little or no cost to their customers.
As a result, software and systems
costs for ICD-10 could be minimal
for many providers.
5.
It’s time to transition to ICD-10.
ICD-10
is foundational to modernizing health
care and improving quality. ICD-10
serves as a building block that allows
for greater specificity and standardized
data that can:
o
Improve coordination of a patient’s
care across providers over time
o
Advance public health research,
public health surveillance, and emergency
response through detection of disease
outbreaks and adverse drug events
o
Support innovative payment models
that drive quality of care
o
Enhance fraud detection efforts
Keep
Up to Date on ICD-10
Visit the CMS ICD-10 website for the latest news
and resources to help you prepare.
Sign up for CMS ICD-10 Industry
Email Updates
and follow us on Twitter.
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